Relationships of serum FGF23 and α-klotho with atherosclerosis in patients with type 2 diabetes mellitus.

BACKGROUND: Compelling evidence suggests that calcium/phosphorus homeostasis-related parameters may be linked to diabetes mellitus and cardiovascular events. However, few studies have investigated the association of fibroblast growth factor 23 (FGF23), α-klotho and FGF23/α-klotho ratio with atherosclerosis in patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: This study was designed to evaluate whether FGF23, α-klotho and FGF23/α-klotho ratio are associated with T2DM and further to explore the relationships between these three factors and atherosclerosis in Chinese patients with T2DM. METHODS: Serum FGF23 and α-klotho levels were measured via an enzyme-linked immunosorbent assay (ELISA) kit, and the carotid intima-media thickness (CIMT) was assessed via high-resolution color Doppler ultrasonography. The associations of serum FGF23, α-klotho and FGF23/α-klotho ratio with atherosclerosis in T2DM patients were evaluated using multivariable logistic regression models. RESULTS: This cross-sectional study involved 403 subjects (207 with T2DM and 196 without T2DM), 41.7% of the patients had atherosclerosis, and 67.2% of the carotid intima were thickened to a thickness greater than 0.9 mm. Compared with those in the lowest tertile, higher tertiles of FGF23 levels and FGF23/α-klotho ratio were positively associated with T2DM after adjusting for covariates, and serum α-klotho concentration was inversely correlated with T2DM (all P values < 0.01). Moreover, elevated serum FGF23 levels and FGF23/α-klotho ratio were positively associated with CIMT and carotid atherosclerosis in T2DM patients (all P values < 0.01). Further spline analysis similarly revealed linear dose‒response relationship (all P values < 0.01). And there was still significant differences in CIMT and carotid atherosclerosis between the highest group of α-klotho and the reference group in T2DM patients (P values = 0.05). CONCLUSIONS: T2DM was positively linearly related to serum FGF23 concentration and FGF23/α-klotho ratio, and negatively correlated with serum α-klotho concentration. Furthermore, both FGF23 and FGF23/α-klotho ratio were positively correlated with CIMT and atherosclerosis in T2DM patients, while α-klotho was inversely correlated with both CIMT and atherosclerosis, although the associations were not completely significant. Prospective exploration and potential mechanisms underlying these associations remain to be further elucidated.

Study on the oxidized gas production characteristics and spontaneous combustion tendency of pre-oxidized water-soaked coal in lean-oxygen environments.

The oxidation characteristics and spontaneous combustion (SC) tendency of raw long-flame coal (RC), water-soaked 200-day coal (S200), pre-oxidized water-soaked coal at 200 °C (O200S200), and pre-oxidized soaked coal at 300 °C (O300S200) in an oxygen-poor environment were investigated using a programmed warming system. The results show that pre-oxidation water-soaked treatment (PWT) promotes the coal-oxygen complex reaction and increases the rate of coal oxygen consumption (OCR) and the rate of carbon and oxygen compound production. The rate of CO and CO2 production of the water-soaked (WS) coal increased by 0.329 mol·(cm3·s)-1 and 0.922 mol·(cm3·s)-1, respectively, compared with that of the original coal sample. PWT reduces the activation energy of coal in the low-temperature oxidation stage (the maximum difference can be up to 110.99 kJ/mol) and enhances the oxidizing and heat-releasing capacity. There was a synergistic effect between the pre-oxidation (PO) and WS treatment, and the lowest comprehensive determination index of the SC propensity of coal in O200S200 samples was 831.92 which was 4.72 lower than that of RC samples, presenting a more SC tendency. Low oxygen concentration has an inhibitory effect on the oxidation characteristic parameters of coal, and the apparent activation energy of the low-temperature oxidation stage of pre-oxidized water-soaked coal (PWC) increased to 206.418 kJ/mol at 3% oxygen concentration. The lower the oxygen concentration of the anoxic environment, the lower the risk of SC of the coal samples. The results of the study can provide theoretical guidance for the identification and prevention of SC disasters in coal seams with shallow burial and close spacing.

Burden and trends of mental disorders in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019.

PURPOSE: Mental disorders remain the leading causes of disability worldwide. We aimed to determine the burden and trends of mental disorders in China from 1990 to 2019. METHODS: The incidence, prevalence, and disability-adjusted life years (DALYs) of mental disorders at national level of China were examined by age, sex, and subcategories. Temporal trends in the age-standardized rates for incidence, prevalence, and DALYs were assessed by the average annual percentage change (AAPC). All estimates are presented as numbers and age-standardized rates, with 95% uncertainty intervals (UIs). RESULTS: The number of incident cases due to mental disorders increased from 42.90 million to 52.72 million, the number of prevalent cases increased from 132.63 million to 160.16 million, and the number of DALYs increased from 15.64 million to 20.29 million during 1990-2019. Decreasing trends were observed in the age-standardized rates for incidence, prevalence and DALYs. Anxiety and depressive disorders were more frequent in women, while ADHD, conduct disorder, and autism spectrum disorders were more common in men. Compared with 1990, the age-specific incidence rates were higher in individuals under 14 years and over 55 years, whereas rates were lower in those aged 15-49 years in 2019. CONCLUSION: The number of incident cases, prevalent cases, and DALYs due to mental disorders gradually increased in China from 1990 to 2019. Anxiety and depressive disorders were the leading causes of burden due to mental disorders, which affected women more than men. Mental disorders deserve greater attention in health policy decision making.

Study on the thermal release characteristics and the correlation transformation mechanism of microscopic active groups of oxidized coal combustion in a deep mined-out area.

With the normalization of deep mining, the risk of residual coal spontaneous combustion (CSC) in deeply mined areas has gradually increased. To investigate the thermal characteristics and microgroup transformation mechanisms during the secondary oxidation of deep-well oxidized coal, a deep-well oxidation process was simulated in a synchronous thermal analyzer, and the thermal parameters of the oxidized coal were tested. The correlated transformation pathways of microscopic active groups was studied by electron paramagnetic resonance (EPR) and in situ diffuse reflectance (in situ FTIR) experiments during the reoxidation of oxidized coal. The results showed that with increasing deep-well ambient temperature and oxidation temperature, the characteristic temperature of coal gradually decreased, exothermic heat release gradually increased, and active aliphatic structures and -OH, -CHO and other active functional groups gradually accumulated and became distributed more uniformly. When the thermal conditions and oxidation temperature were very high (> 160 °C), the active free radicals in the oxidized coal were rapidly consumed, resulting in a gradual decrease in the characteristic temperature and heat release during the secondary oxidation process, while the contents of peroxy and carboxyl groups continued to increase. In the slow oxidation stage of oxidized coal, methyl groups were mainly transformed with hydroxyl and peroxide groups (r > 0.96), and the associated oxidative consumption of -CHO and -COOH mainly occurred in the rapid oxidation stage (r > 0.99). Geminal diols and peroxy groups are important intermediates in the coal-oxygen composite reaction process. With an increase in the deep-well temperature and initial oxidation temperature, the reoxidation tendency and heat release capacity of residual coal in the goaf gradually increased, and the risk of CSC intensified. The research results provide a theoretical reference for the prevention and control of coal fires in deep mines and play an important role in guiding environmental management and gas emissions reduction measures in mining areas.

Enhancing lithium storage performance of bimetallic oxides anode by synergistic effects.

Spinel bimetallic transition metal oxide anode such as ZnMn2O4, has drawn increasing interest due to attractive bimetal interaction and high theoretical capacity. While it suffers from huge volume expansion and poor ionic/electronic conductivity. Nanosizing and carbon modification can alleviate these issues, while the optimal particle size within host is unclear yet. We here propose an in-situ confinement growth strategy to fabricate pomegranate-structured ZnMn2O4 nanocomposite with calculated optimal particle size in mesoporous carbon host. Theoretical calculations reveal favorable interatomic interactions between the metal atoms. By the synergistic effects of structural merits and bimetal interaction, the optimal ZnMn2O4 composite achieves greatly improved cycling stability (811 mAh g-1 at 0.2 A g-1 after 100 cycles), which can maintain its structural integrity upon cycling. X-ray absorption spectroscopy analysis further confirms delithiated Mn species (Mn2O3 but little MnO). Briefly, this strategy brings new opportunity to ZnMn2O4 anode, which could be adopted to other conversion/alloying-type electrodes.

The phenotype and prediction of long-term physical, mental and cognitive COVID-19 sequelae 20 months after recovery, a community-based cohort study in China.

Long-term sequelae clustering phenotypes are important for precise health care management in COVID-19 survivors. We reported findings for 1000 survivors 20 months after diagnosis of COVID-19 in a community-based cohort in China. Sequelae symptoms were collected from a validated questionnaire covering 27 symptoms involved in five organ systems including self-reported physical condition, dyspnea, cognitive function and mental health. The generalized symptoms were reported with the highest rate (60.7%), followed by the mental (48.3%), cardiopulmonary (39.8%), neurological (37.1%; cognitive impairment, 15.6%), and digestive symptoms (19.1%). Four clusters were identified by latent class analysis: 44.9% no or mild group (cluster 1), 29.2% moderate group with mainly physical impairment (cluster 2), 9.6% moderate group with mainly cognitive and mental health impairment (cluster 3), and 16.3% severe group (cluster 4). Physical comorbidities or history of mental disorders, longer hospitalization periods and severe acute illness predicted severe group. For moderate group, adults less than 60 years, with physical comorbidities and severe acute illness were more likely to have physical symptoms, while adult women with longer hospitalization stays had increased risk of cognitive and mental health impairment. Overall, among more than half of community COVID-19 survivors who presented moderate or severe sequelae 20 months after recovery, three-tenth had physical vulnerability that may require physical therapy aiming to improve functioning, one-tenth mental or cognitive vulnerable cases need psychotherapy and cognitive rehabilitation, and one-sixth severe group needs multidisciplinary clinical management. The remaining half is free to clinical intervention. Our findings introduced an important framework to map numerous symptoms to precise classification of the clinical sequelae phenotype and provide information to guide future stratified recovery interventions.

Three-in-one oxygen-deficient titanium dioxide in a pomegranate-inspired design for improved lithium storage.

Defects engineering has played an ever-increasing important role in electrochemistry, especially secondary lithium batteries. TiO2 is regarded as a promising anode due to its attractive cycling stability, low volume strain and great abundance, while challenges of intrinsic poor electrical and ionic conductivity remain to be addressed. Herein, we report a three-in-one oxygen vacancy (VO)-involved pomegranate design for TiO2-x/C composite anode, which provides highly improved electrical conduction, shortened Li+ pathway and promoted Li+ redox. N-doped mesoporous carbon acts as a robust scaffold to support the whole structure, electron highway and efficient reductant to generate VO on TiO2 nanoparticles during crystallization. Theoretical calculations reveal the crucial role of surface VO on TiO2 in Li electrochemistry. Resultantly, the optimal TiO2-x/C anode achieves significantly enhanced cycling performance (203 mAh/g retained after 2000 cycles at 1 A/g). Postmortem analysis reveals the robustness of VO and reasonable structure stability upon cycles for improved battery performance.

Influencing Factors and Risk Assessment of Precipitation-Induced Flooding in Zhengzhou, China, Based on Random Forest and XGBoost Algorithms.

Due to extreme weather phenomena, precipitation-induced flooding has become a frequent, widespread, and destructive natural disaster. Risk assessments of flooding have thus become a popular area of research. In this study, we studied the severe precipitation-induced flooding that occurred in Zhengzhou, Henan Province, China, in July 2021. We identified 16 basic indicators, and the random forest algorithm was used to determine the contribution of each indicator to the Zhengzhou flood. We then optimised the selected indicators and introduced the XGBoost algorithm to construct a risk index assessment model of precipitation-induced flooding. Our results identified four primary indicators for precipitation-induced flooding in the study area: total rainfall for three consecutive days, extreme daily rainfall, vegetation cover, and the river system. The Zhengzhou storm and flood risk evaluation model was constructed from 12 indicators: elevation, slope, water system index, extreme daily rainfall, total rainfall for three consecutive days, night-time light brightness, land-use type, proportion of arable land area, gross regional product, proportion of elderly population, vegetation cover, and medical rescue capacity. After streamlining the bottom four indicators in terms of contribution rate, it had the best performance, with an accuracy rate reaching 91.3%. Very high-risk and high-risk areas accounted for 11.46% and 27.50% of the total area of Zhengzhou, respectively, and their distribution was more significantly influenced by the extent of heavy rainfall, direction of river systems, and land types; the medium-risk area was the largest, accounting for 33.96% of the total area; the second-lowest-risk and low-risk areas together accounted for 27.09%. The areas with the highest risk of heavy rainfall and flooding in Zhengzhou were in the Erqi, Guanchenghui, Jinshui, Zhongyuan, and Huizi Districts and the western part of Xinmi City; these areas should be given priority attention during disaster monitoring and early warning and risk prevention and control.

Anti-Inflammatory Dietary Diversity and Depressive Symptoms among Older Adults: A Nationwide Cross-Sectional Analysis.

The purpose of this study was to associate the anti-inflammatory dietary diversity and depressive symptoms among a nationwide sample of Chinese older adults. We used data from the 2018 wave of Chinese longitudinal healthy longevity survey (CLHLS). We assessed depressive symptoms using the 10 items of the center for epidemiologic studies depression scale (CES-D-10). Based on the dietary diversity index (DDI) generated by previous studies, we construct two novel indicators: the protein-enriched dietary diversity index diet (PEDDI) and the anti-inflammatory dietary diversity index diet (AIDDI). We used multivariate logistic models to evaluate the associations of DDI, PEDDI, and AIDDI with depressive symptoms, statistically adjusted for a range of potential confounders. A total of 12,192 participants (mean age 83.6 years) were included in the analysis. We found that participants with a higher score of DDI (OR = 0.91, 95% CI: 0.89-0.92) and PEDDI (OR = 0.91, 95% CI: 0.88-0.93) showed lower odds of having depressive symptoms, while the association between AIDDI and depressive symptoms was more marked (OR = 0.80, 95% CI: 0.78-0.83). The associations remained in subgroup analyses and sensitivity analyses. The results indicate that intaking diversified diet, particularly anti-inflammatory foods, may be associated with a lower risk of depressive symptoms. The findings of this study, if confirmed as causal, provide evidence that an intervention of adopting an anti-inflammatory diversified diet may reduce the burden of depression among older adults.

Impacts of Social Inequality, Air Pollution, Rural-Urban Divides, and Insufficient Green Space on Residents' Health in China: Insight from Chinese General Social Survey Data Analysis.

Attention to physical and mental health is becoming more intensive. In China, factors and mechanisms are now a focus of research. We used dynamic air quality monitoring data and the Chinese General Social Survey (CGSS) to assess the spatial differences and the coupling between subjective and objective air pollution. In addition, a logistic model was used to explore the impact mechanisms of social inequality, air pollution, food safety, and lack of green space on health. The results show that (1) the impact of subjective and objective air pollution on the health level of the population is significant; (2) income inequality, air pollution, food pollution, and travel behavior significantly affect the residents' health; and (3) environmental health has a significant differentiation mechanism between urban and rural areas. The negative health effects of air pollution and insufficient green space are more significant in cities; food pollution is more likely in rural areas. In terms of socioeconomic inequality, gender, family size, travel, and physical exercise had no significant effect on rural health. Health improvement was higher in the low-income group than in the high-income group. The adverse effect of travel behavior on environmental pollution is conducive to improving health. Therefore, social equality, strictly controlled environmental pollution, exercise, and travel can help narrow the gap between rich and poor, promote urban-rural health equity, and improve human health.

Six-Degree-of-Freedom Posture Measurement Technologies Using Position Sensitive Detectors (PSDs): State of the Art.

Six degree-of-freedom (6-DOF) posture measurement is an important academic research topic which has been broadly applied in many fields. As a high-speed photoelectronic sensor with ultra-high resolution and precision, position sensitive detector (PSD) has shown to be one of the most competitive candidates in 6-DOF measurement. This review presents the research progress of PSD-based 6-DOF posture measurement systems in the field of large-scale equipment assembly, ultra-precision manufacturing and other emerging areas. A total of six methods for implementing 6-DOF measurement are summarized and their advantages and limitations are discussed. Meanwhile, the paper illustrates challenges, potential solutions and future development trends.

Microbiome analysis reveals the effects of black soldier fly oil on gut microbiota in pigeon.

The gut microbiota plays a vital roles in poultry physiology, immunity and metabolism. Black soldier fly oil is known to have a positive effect on the gut microbiota. However, the specific effect of black soldier fly oil on the composition and structure of the gut microbiota of the pigeon is unknown. In this experiment, 16S rDNA high-throughput sequencing was performed to study the effect of different doses of black soldier fly oil on the changes of pigeon intestinal microbes. Results indicated that the different doses of black soldier fly oil had no effect on the gut microbial diversity of the pigeon. Although the dominant phyla (Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria) and genus (uncultured_bacterium_f_Lachnospiraceae and Desulfovibrio) in control group and experimental group with different doses were the same, the abundances of some beneficial bacteria (Megasphaera, Intestinimonas, Prevotella_9, Lachnospiraceae_UCG-001, Faecalibacterium, Coprococcus_2, Parabacteroides, Megasphaera, Leuconostoc, Prevotellaceae_UCG-001, Lactococcus, Ruminococcaceae_UCG-014, and Coprococcus_2) increased significantly as the concentration of black soldier fly oil increased. Taken together, this study indicated that black soldier fly oil supplementation could improve gut microbial composition and structure by increasing the proportions of beneficial bacteria. Notably, this is the first report on the effects of black soldier fly oil on the gut microbiota of pigeon, which contribute to understanding the positive effects of black soldier fly oil from the gut microbial perspective.

Workforce situation of the Chinese mental health care system: results from a cross-sectional study.

BACKGROUND: High-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country's mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China. METHODS: This study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis. RESULTS: Workforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (ß = - 0.88), self-experience (ß = - 0.59) and professional supervision (ß = - 1.26) significantly influenced psychotherapy capacity (P<0.001). CONCLUSIONS: Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

Structural, physicochemical properties, and digestibility of lotus seed starch-conjugated linoleic acid complexes.

This paper describes a new method combining octenyl succinic anhydride (OSA) esterification and high hydrostatic pressure for starch modification, which interacts with conjugated linoleic acid (CLA) to form an octenyl succinic anhydride-lotus seed starch-conjugated linoleic acid (OSA-LS-CLA) complex. This method proves the formation of complex observed by fourier transform infrared spectroscopy and complex index. The stable structure of the complex was derived from increasing molecular weight by introducing macromolecular conjugated linoleic acid and the higher crystallinity than original starch observed by X-ray diffraction. The formation method and changes of complex were observed by scanning electron microscopy and confocal laser scanning microscope. The solubility and swelling power of the complex increases as the temperature increased, significantly at 75 °C. The formation of the OSA-LS-CLA complex significantly reduced the digestion rate of LS, which was 26 % lower than that of LS. These results indicate that the OSA-LS-CLA under high hydrostatic pressure can form a complex with stable structure, which makes up for the deficiency of raw starch to a certain extent. And the formation of this structure can improve the thermal stability of the complex and has strong digestion resistance, which provides a potential direction for further research in reducing starch digestibility.

From Deep-Level Similarity to Subordinate Moqi: The Mediating Role of Leader-Member Exchange.

Fostering subordinate moqi is a significant method to improve the cooperating quality and promote positive outcomes. However, little is known about the influencing factors and mechanisms of subordinate moqi. To address this issue and explore the influencing factors of subordinate moqi, we draw on self-categorization theory to develop a mediation model to examine whether and how deep-level similarity affects subordinate moqi, casting the leader-member exchange (LMX) as a mediator. A two-wave online survey was conducted and 316 data was collected. A Structure Equation Modeling analysis was used to test all hypotheses with Mplus 7. Results showed that the deep-level similarity could positively predict subordinate moqi and LMX, respectively. Additionally, LMX was a significant predictor of subordinate moqi as well as it mediated the positive relationships between deep-level similarity and subordinate moqi. These findings expand our understanding of the antecedents of subordinate moqi. It is suggested that developing subordinates' deep-level similarity with supervisors and LMX relationships are instrumental in cultivating subordinate moqi which promote positive outcomes. Organizations should integrate effective management programs into managerial strategies to enhance deep-level similarity and LMX, in turn, fosters subordinate moqi.

Patterns and influencing factors of COVID-19 vaccination willingness among college students in China.

BACKGROUND: Vaccination is an important preventive measure against the coronavirus disease 19 (COVID-19) pandemic. We aimed to examine the willingness to vaccination and influencing factors among college students in China. METHODS: From March 18 to April 26, 2021, we conducted a cross-sectional online survey among college students from 30 universities in Wuhan, Hubei Province, China. The survey was composed of the sociodemographic information, psychological status, experience during pandemic, the willingness of vaccination and related information. Students' attitudes towards vaccination were classified as 'vaccine acceptance', 'vaccine hesitancy', and 'vaccine resistance'. Multinomial logistic regression analyses were performed to identify the influencing factors associated with vaccine hesitancy and resistance. RESULTS: Among 23,143 students who completed the survey, a total of 22,660 participants were included in the final analysis with an effective rate of 97.9% after excluding invalid questionnaires. A total of 60.6% of participants would be willing to receive COVID-19 vaccine, 33.4% were hesitant to vaccination, and 6.0% were resistant to vaccination. Social media platforms and government agencies were the main sources of information vaccination. Worry about the efficacy and adverse effects of vaccine were the top two common reason of vaccine hesitancy and resistance. Multiple multinomial logistic regression analysis identified that participants who worried about the adverse effects of vaccination were more likely to be vaccine hesitancy (aOR = 2.44, 95% CI = 2.30, 2.58) and resistance (aOR = 2.71, 95% CI = 2.40, 3.05). CONCLUSION: More than half of college students are willing to receive the COVID-19 vaccine, whereas nearly one-third college students are still hesitant or resistant. It is crucial to provide sufficient and scientific information on the efficacy and safety of vaccine through social media and government agencies platforms to promote vaccine progress against COVID-19 and control the pandemic in China.

Efficacy and practice of facemask use in general population: a systematic review and meta-analysis.

In recent decades, respiratory infections, including SARS, HINI and the currently spreading COVID-19, caused by various viruses such as influenza and coronavirus have seriously threatened human health. It has generated inconsistent recommendations on the mandatory use of facemasks across countries on a population level due to insufficient evidence on the efficacy of facemask use among the general population. This meta-analysis aimed to explore (1) the efficacy of facemask use on preventing respiratory infections, and (2) the perceptions, intentions, and practice about facemask use among the general population worldwide. We searched PubMed, MEDLINE, Web of Science, Cochrane, bioRxiv, and medRxiv databases since inception to August 17, 2020. From 21,341 records identified, eight RCTs on facemask in preventing infections and 78 studies on perception, intention, and practice of facemask use among the general population were included in the analysis. The meta-analysis of RCTs found a significant protective effect of facemask intervention (OR = 0.84; 95% CI = 0.71-0.99; I2 = 0%). This protective effect was even more pronounced when the intervention duration was more than two weeks (OR = 0.76; 95% CI = 0.66-0.88; I2 = 0%). The meta-analysis of observational studies on perception, intention, and practice on facemask use showed that 71% of respondents perceived facemasks to be effective for infection prevention, 68% of respondents would wear facemasks, and 54% of respondents wore facemasks for preventing respiratory infections. Differences in perception, intention, and practice behavior of facemask use in different regions may be related to the impact of respiratory infections, regional culture, and policies. The governments and relevant organizations should make effort to reduce the barriers in the use of facemasks.

Nightmares mediate the association between traumatic event exposure and suicidal ideation in frontline medical workers exposed to COVID-19.

BACKGROUND: Trauma experience increases the risk of suicidal ideation, but little is known about potentially psychological mechanisms underlying this relationship. This study aims to examine the relationship between coronavirus disease 2019 (COVID-19)-related traumatic event (CTE) exposure and suicidal ideation among hospital workers, and identify mediating roles of sleep disturbances in this relationship. METHODS: Workers in seven designated hospitals in Wuhan, China, were invited to participate in an online survey from May 27, 2020, to July 31, 2020. Participants completed a self-report questionnaire to evaluate demographic characteristics, level of CTE exposures, nightmare frequency, insomnia severity, symptoms of depression and anxiety, and suicidal ideation. A series of correlation analyses were performed, and a mediation model was generated to examine correlations between CTE exposure, sleep disturbances, and suicidal ideation. RESULTS: A total of 16,220 hospital workers were included in the final analysis, 13.3% of them reported suicidal ideation in the past month. CTE exposure was significantly associated with insomnia severity, nightmare frequency, and suicidal ideation. After controlling potential confounders, nightmares but not insomnia, depression, or anxiety were shown to be independent risk factors for suicidal ideation. Pathway analyses showed that the relationship between CTE exposure and suicidal ideation was fully mediated by nightmares (proportion mediated 66.4%) after adjusting for demographic characteristics and psychological confounders. LIMITATIONS: Cross-sectional design precluded the investigation of causal relationships. CONCLUSIONS: CTE exposure increases risk of hospital workers' suicidal ideation that is mediated by nightmares, suggesting nightmares intervention might be considered as a component when developing suicide prevention strategies.

Relationship of Problematic Smartphone Use, Sleep Quality, and Daytime Fatigue Among Quarantined Medical Students During the COVID-19 Pandemic.

Background: The COVID-19 pandemic brought about great transformation to medical education mode. Although mobile communication devices played a crucial role in online learning among quarantined university students, the potential smartphone addition problems, negative health behaviors, and psychological symptoms need considerable attention. This study examined the relationship of problematic smartphone use (PSU), sleep quality, and daytime fatigue among medical students. Methods: A web-based survey was conducted in six polyclinic hospitals in Beijing between February and May 2020. 1016 participants (26.01 ± 2.46 years, 65.16% female) completed self-report measurements including Short Version Smartphone Addiction Scale (SAS-SV), Athens Insomnia Scale (AIS), and Subjective Fatigue Scale (FS). Spearman correlation coefficients and multiple regression models were used to analyze the association among PSU, sleep quality, and daytime fatigue. We used structural equation modeling to test the mediating effect of sleep quality between PSU and daytime fatigue. Results: 49.70% of the participants had PSU. Significant positive correlations were found among SAS-SV, AIS, and FS scores (r = 0.35-0.61, P S < 0.001). Subjects with PSU were more likely to report sleep disturbance (ß = 1.07, P < 0.001, OR = 2.91, 95%CI = 2.17-3.91), physical fatigue (ß = 1.16, P < 0.001, OR = 3.18, 95%CI = 2.45-4.15), and mental fatigue (ß = 0.88, P < 0.001, OR = 2.42, 95%CI = 1.86-3.14). The indirect effect of PSU on physical fatigue and mental fatigue mediated by sleep quality accounted for 50.03 and 45.43% of the total effect, respectively. Conclusions: PSU was significantly associated with sleep disturbance and fatigue among medical students during the COVID-19 pandemic. Sleep quality mediated the relationship between PSU and daytime fatigue. Our results provide valuable information for maintaining medical students' health status and constructing online education structures.

Long-Term Impact of COVID-19 on Mental Health among the General Public: A Nationwide Longitudinal Study in China.

COVID-19 might have long-term mental health impacts. We aim to investigate the longitudinal changes in mental problems from initial COVID-19 peak to its aftermath among general public in China. Depression, anxiety and insomnia were assessed among a large-sample nationwide cohort of 10,492 adults during the initial COVID-19 peak (28 February 2020 to 11 March 2020) and its aftermath (8 July 2020 to 8 August 2020) using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Insomnia Severity Index. We used generalized estimating equations and linear mixed models to explore factors associated with long-term mental health symptoms during COVID-19. During the five months, mental health symptoms remained consistently elevated (baseline 46.4%; follow-up 45.1%). Long-term depression, anxiety and insomnia were associated with several personal and work-related factors including quarantine (adjusted OR for any mental health symptoms 1.31, 95%CI 1.22-1.41, p < 0.001), increases in work burden after resuming work (1.77, 1.65-1.90, p < 0.001), occupational exposure risk to COVID-19 (1.26, 1.14-1.40, p < 0.001) and living in places severely affected by initial COVID-19 peak (1.21, 1.04-1.41, p = 0.01) or by a COVID-19 resurgence (1.38, 1.26-1.50, p < 0.001). Compliance with self-protection measures, such as wearing face masks (0.74, 0.61-0.90, p = 0.003), was associated with lower long-term risk of mental problems. The findings reveal a pronounced and prolonged mental health burden from the initial COVID-19 peak through to its aftermath in China. We should regularly monitor the mental health status of vulnerable populations throughout COVID-19.